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Confabulation

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Last Update: August 28, 2023.

Definition/Introduction

Confabulation is a neuropsychiatric disorder wherein a patient generates a false memory without the intention of deceit.[1] The patient believes the statement to be truthful, hence the descriptive term “honest lying.”[2] The hypothesis is that the patient generates information as a compensatory mechanism to fill holes in one’s memories.[3] It functions for self-coherence, integration of memories, and self-relevance.[4][1] Confabulations can include small details such as birthdays, or they may be fantastical and more broadly based.[5] They can be believable or bizarre. Presenting patients with contradictory information may further perpetuate confabulation in an attempt to explain their account.

Issues of Concern

Associated Conditions

The most common reports of confabulation are in patients with Korsakoff syndrome from Wernicke encephalopathy, wherein patients have anterograde amnesia in addition to confabulations.[6] It has been seen in several other disease processes to include Alzheimer dementia, traumatic brain injury, schizophrenia, bipolar disorder, anterior communicating artery aneurysms, and cortical blindness with Anton syndrome. It can, however, also present in otherwise healthy patients.[7][8][9][3]

Mechanism

Multiple reported lesions have correlations with the phenomenon. While most disorders associated with confabulation are related to lesions in the orbitofrontal or ventromedial prefrontal cortex of the frontal lobe, errors in processing may also occur within the hypothalamus, mammillary bodies, and the dorsomedial nucleus of the thalamus.[10][8][6][3][9] Due to the complex physiology, it is difficult to determine the exact mechanism of false memories. There are multiple theories regarding the evolution of and motivation behind confabulation, but there is no conclusive data.[5] Memory tests may identify errors in executive function, temporal context confusion, or reduced memory capacity.[9]

Spontaneous vs. Provoked Confabulation

Two types of confabulation can be distinguished. Provoked confabulations can be discovered by directly questioning and prompting a false memory.[5] This type commonly correlates with an impairment in autobiographical and semantic memory such as dates, places, and common history. For example, one asks the patient, “Who was the forty-fourth president of the United States?” the patient would then reply incorrectly instead of responding with “I don’t know.”[3][8] Spontaneous confabulations are memories elicited without an external trigger, and generally, do not occur within an interview. Their trigger is from an individual confusing chronology or attempting to explain situations to themselves.[5] Spontaneous confabulations may reveal themselves in standard day to day conversations, such as a patient divulging false information randomly at the dinner table.

Delusions vs. Confabulation

While confabulations appear to be false memories, delusions are more akin to false beliefs.[11][12] Confabulations are more commonly associated with Korsakoff syndrome, while delusions more commonly correlate with schizophrenia. That said, both errors in information processing may exist in both disorders. Research into the motivations behind confabulations and delusions has attempted to differentiate these disorders, but this has not been conclusive.[11][12][13] As such, confabulations and delusions may prove to be different manifestations along the same spectrum.

Clinical Significance

Treatment most commonly revolves around treating the underlying disorder, such as using thiamine to treat Korsakoff syndrome or antipsychotic medications to treat schizophrenia. Interprofessional cognitive rehabilitation, however, may also be helpful. Specific interventions, such as maintaining a diary, and specific therapies such as self-monitoring training may also be efficacious.[4][11][1][14]

Review Questions

References

1.
Fotopoulou A. False selves in neuropsychological rehabilitation: the challenge of confabulation. Neuropsychol Rehabil. 2008 Oct-Dec;18(5-6):541-65. [PubMed: 18609017]
2.
Berrios GE. Confabulations: a conceptual history. J Hist Neurosci. 1998 Dec;7(3):225-41. [PubMed: 11623845]
3.
El Haj M, Larøi F. Provoked and spontaneous confabulations in Alzheimer's disease: An examination of their prevalence and relation with general cognitive and executive functioning. Psychiatry Clin Neurosci. 2017 Jan;71(1):61-69. [PubMed: 27981677]
4.
Mendez MF, Fras IA. The false memory syndrome: experimental studies and comparison to confabulations. Med Hypotheses. 2011 Apr;76(4):492-6. [PMC free article: PMC3143501] [PubMed: 21177042]
5.
Schnider A, von Däniken C, Gutbrod K. The mechanisms of spontaneous and provoked confabulations. Brain. 1996 Aug;119 ( Pt 4):1365-75. [PubMed: 8813298]
6.
Arts NJ, Walvoort SJ, Kessels RP. Korsakoff's syndrome: a critical review. Neuropsychiatr Dis Treat. 2017;13:2875-2890. [PMC free article: PMC5708199] [PubMed: 29225466]
7.
Martín Juan A, Madrigal R, Porta Etessam J, Sáenz-Francés San Baldomero F, Santos Bueso E. Anton-Babinski syndrome, case report. Arch Soc Esp Oftalmol (Engl Ed). 2018 Nov;93(11):555-557. [PubMed: 29859732]
8.
Shakeel MK, Docherty NM. Confabulations in schizophrenia. Cogn Neuropsychiatry. 2015;20(1):1-13. [PMC free article: PMC4229437] [PubMed: 25078663]
9.
Fujikawa M, Nishio Y, Kakisaka Y, Ogawa N, Iwasaki M, Nakasato N. Fantastic confabulation in right frontal lobe epilepsy. Epilepsy Behav Case Rep. 2016;6:55-7. [PMC free article: PMC5014757] [PubMed: 27630818]
10.
Dalla Barba G, La Corte V. A neurophenomenological model for the role of the hippocampus in temporal consciousness. Evidence from confabulation. Front Behav Neurosci. 2015;9:218. [PMC free article: PMC4549641] [PubMed: 26379515]
11.
Langdon R, Turner M. Delusion and confabulation: overlapping or distinct distortions of reality? Cogn Neuropsychiatry. 2010 Jan;15(1):1-13. [PubMed: 20043251]
12.
McKay R, Kinsbourne M. Confabulation, delusion, and anosognosia: motivational factors and false claims. Cogn Neuropsychiatry. 2010 Jan;15(1):288-318. [PubMed: 19946808]
13.
Kopelman MD. Varieties of confabulation and delusion. Cogn Neuropsychiatry. 2010 Jan;15(1):14-37. [PubMed: 19753493]
14.
Schnider A. Spontaneous confabulation, reality monitoring, and the limbic system--a review. Brain Res Brain Res Rev. 2001 Oct;36(2-3):150-60. [PubMed: 11690611]

Disclosure: Amanda Wiggins declares no relevant financial relationships with ineligible companies.

Disclosure: Jessica Bunin declares no relevant financial relationships with ineligible companies.

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